Treatments used by patients with ankylosing spondylitis comparison with the treatment preferences of rheumatologists.

To determine the treatments used by patients with ankylosing spondylitis (AS), and to compare these treatments with those recommended by rheumatologists, we surveyed 226 patients with AS, and also surveyed 123 American rheumatologists about their judgments of the effectiveness of different treatments for AS. One hundred eighty-eight patients (83.2%) used nonsteroidal anti-inflammatory drugs (NSAIDs), 62 patients (27.4%) used analgesics, 38 patients (16.8%) used second-line medications, and 22 patients (9.7%) used no medications. Fifty-seven patients (25.2%) were using indomethacin, 8 (3.5%) were using phenylbutazone, 26 (11.5%) were using sulfasalazine, 12 (5.3%) were using methotrexate, and 28 (12.4%) were receiving physical therapy. Results were similar in the subgroup of patients (N = 112) who rated their AS moderately or very active. In contrast, 81% of rheumatologists rated indomethacin either extremely effective or very effective in treating active AS, as did 90% for phenylbutazone. Eighty-two percent of rheumatologists recommended indomethacin for most patients with active AS; 64% recommended sulfasalazine, and 20% recommended methotrexate for most patients who had inadequate responses to NSAIDs. Many patients who report active AS, including many of those treated by rheumatologists, are not using treatments, including drugs and physical therapy, commonly recommended by rheumatologists for patients with active AS. Understanding the reasons for this discordance may suggest ways to improve the health of these patients. Clinicians should review and discuss the treatments received by their patients with AS to ensure that appropriate treatment is being provided.